A new role for the doctor-manager? About the changing role of the medical hospital director in a more competitive and politicized environment

1
A new role for the doctor-manager?About the
changing role of the medical hospital director in
a more competitive and politicized environment

• Wilma van der Scheer, Kim Putters
• Erasmus University Rotterdam
• The Netherlands

2
Outline

1. The Dutch case
2. Theories used
3. Methods
4. Quantitative outcomes
5. Qualitative outcomes
6. Conclusions and discussion

3
Hospital governance

1. Integration Act (2000) executive board has final
   responsibility
2. In practice (since mid 1990s) continuous
   negotiation between Staff Executive and Executive
   Board
3. Health Insurance Act (2006) new
   governance-structures

4
Changes in governance

1. More competition
2. Separation between policy and implementation
3. Negotiations over means and ends are left to
   field parties
4. ? displacement of politics, politicization of
   management (Beck 1994, Bovens 1995)

5
Theoretical point of departure

• Hospital as a negotiated order (Abbott 1988)
• With different interests (public, private,
  professional and patient)
• Negotiating between different worlds (cure, care,
  community and control) (Glouberman and Mintzberg
  2001)

6
Methods

• Survey (n 200, response 35)
• Interviews in 10 organizationswith 5 hospital
  directors, 4 staff executives, 3 chairpersons of
  the supervisory boardof organizations with a
  med.dir. from inside, organizations with a
  med.dir. from outside, organizations without a
  med.dir. and 2 executive searchers

7
Conclusions quantitative study

1. Very experienced managers, broad educated, but
   with little experience outside health-care
2. Act on the boarder of internal affairs and
   external affairs, but with more attention for
   internal affairs
3. Feel very responsible for matters of care/quality
   than for finances
4. Little attention for entrepreneurial activities
5. Take less part in the public debate about health
   care

8
Conclusions qualitative study

• Natural distribution of roles
• Medical background alone is not enough
• Different argumentations (cultural, relational,
  knowledge-based, principle)
• Different perspectives, different expectations

9
Different perspectives, different expectations (1)

• Executives med. dir. is a connector, he/she is
  likely to realize more support from medical staff
  for hospital policy
• Medical director we are not different form other
  directors, only we understand doctors better

10
Different perspectives, different expectations (2)

• Staff executive med. dir. is a representative,
  who understands our interests
• Sup. board med. dir. is a risk manager, who can
  prevent problems between executive board and
  medical staff

11
Different perspectives, different expectations (3)

• Exec. searcher med. dir. can build bridges
  between managerial and medical world (but
  communication skills are more important)

12
Conclusions

• More attention for educating/training doctors in
  management
• Different perspectives, different expectations
• Dominance of complicated relationship
  doctors-managers
• Towards a different role? (e.g. from managing
  professionals to managing patient experiences?)
• Requires expectation management!